Trabalho em equipe na atenção primária: a experiência de Portugal

Abstract

To analyze the work of health care teams delivering primary care in Portugal. We performed an evaluative research project, with a qualitative case study design. Data were obtained through semi-structured interviews, direct observation, and analysis of documents. We interviewed managers, workers, and users in 11 family health units (USF) in Portugal, for a total of 71 participants. Content analysis was used to assess the interviews. Teams included a physician, a nurse, and an administrative employee. Each team was in charge of 1 250 to 2 060 users. A striking characteristic of the Portuguese experience was the voluntary and autonomous setup of teams at the USF, based on personal affinity. The services provided at the USF included a basic "service package" as well as activities of surveillance, health promotion, disease prevention, care of acute disease, clinical follow-up of patients with chronic or multiple diseases, home care, and networking with other services (hospital care). Difficulties in providing home care were reported. Electronic systems were widely available. According to interviewees, the changes resulting from the implementation of USF included improved user access to services, higher quality of care, and goal-oriented teamwork, guided by an action plan. Even without a coordinating role in the health care network, the delivery of primary health care through teams was positively evaluated in Portugal as promoting increased access, continuity, and humanization of health services.